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 New Quality Goals Set for Long Term, Post-Acute, and Assisted Living

Quality improvement continues to gain speed in long term and post-acute care, and providers are working together to identify measurable targets that are appropriate for this care setting. At its National Quality Summit in New Orleans, the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) announced its new goals—aligned with federal priorities—for quality measurement in the coming three years.
Specifically, the goals are:
--Safely reduce long- and short-stay hospitalizations by improving 10 percent—or maintain a rate of 10 percent or less;
--Improve functional outcomes (self-care and mobility) by 15 percent;
--Improve long- and short-stay satisfaction by 10 percent—or achieve a rate of 90 percent or greater; and
--Safely reduce the off-label use of antipsychotics by 10 percent—or maintain a rate of 8 percent or less in long-stay residents and a rate of 1 percent or less in short-stay.
Appropriately, AHCA/NCAL identified separate three-year goals for assisted living communities, which -- while they are seeing a growing number of residents with higher acuity and multiple co-morbidities—remain a distinct care setting from skilled nursing centers and subject more to state versus federal oversight. The goals identified for assisted living are:
--Reduce turnover among direct care staff to a rate of 50 percent or less;
--At least 90 percent of customers (residents and/or families) are satisfied with their experience;
--Safely reduce hospital readmission within 30 days of hospital discharges to a rate of 20 percent or less; and
--Safely reduce the off-label use of antipsychotics to rate of 15 percent or less.
Quality measures set for hospitals and outpatient settings often aren’t appropriate for long term and post-acute care settings, so providers have taken the lead on working with the Centers for Medicare & Medicaid Services (CMS) to identify measures specifically for this patient population. This is part of AHCA/NCAL’s ongoing Quality Initiative designed to improve quality in this care setting and support providers in their quality improvement efforts.
While quality reporting isn’t mandated for assisted living, AHCA/NCAL encourages efforts by these settings to document, track, and analyze data—to self-report instead of waiting for state or federal mandates. Moving forward, assisted living providers will likely be participating in integrated care models such as accountable care organizations, and they will need data to show their value and track progress. While overall progress is not yet viable to report, the number of assisted living communities self-reporting to AHCA/NCAL is growing.
“Our members are the driving force behind the significant quality advancements our profession continues to make,” says AHCA/NCAL President and Chief Executive Officer Mark Parkinson. “This next phase of the Quality Initiative sets the bar even higher. The goals we have established will improve the lives of the patients, residents, and families we service.”
NCAL Executive Director Scott Tittle adds, “Continuing to focus on these key quality areas not only betters the lives of residents but helps long term care providers succeed in an evolving health care market. All of the goals intertwine to ensure excellence and person-centered care. We are humbled by the commitment our members have shown to the Quality Initiative and have no doubt they will persist to achieve these goals.”
Over the years, providers have embraced quality improvement goals and produced measurable results. For instance, since 2012, over half—57 percent—of AHCA/NCAL skilled nursing member organizations have safely reduced the off-label use of antipsychotic medications by 30 percent. In fact, AHCA members beat national trends with their results. For the first quarter of 2013, for example, the rate of long-stay residents receiving an antipsychotic in AHCA member centers was 21.3 percent, compared to 21.7 percent nationally. AHCA members also have safely prevented more than 142,000 patients from returning to the hospital—a 12 percent reduction since 2011.
 AHCA will use CMS measures to track progress on antipsychotic usage and measures endorsed by the National Quality Forum (NQF) to monitor progress on rehospitalizations, functional outcomes, and customer satisfaction. For the assisted living goals, measures developed by AHCA/NCAL will be used.
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